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Workers’ compensation market: ClearPrice strives to bring clarity

SAN DIEGO – Pat Sullivan sees no need for re-billing vendors in the workers’ compensation market for HME. To prove it, he has launched a company called ClearPrice Networks to give providers and payers a more direct way to bill and pay.

Here’s what Sullivan, whose career spans everything from being a claims adjuster to founding a PPO, had to say about why the workers’ comp market for HME is growing and how ClearPrice Networks is helping to make it more lucrative for providers.

HME News: Why do you see re-billing vendors as an obstacle to the workers’ comp market?

Pat Sullivan: This is one of the few areas where you don’t bill the payer directly and you don’t get paid directly. These re-billing vendors essentially pay the DME provider about two-thirds of what they bill the payer and they take 60 to 120 days to do it. In a world where I can Square Cash you money instantaneously, that’s unacceptable.

HME: But you’re still a middleman of sorts, aren’t you?

Sullivan: When I think of a middleman, I think of someone who is involved in the financial transaction and who takes a piece of it along the way. Obviously, we need to get paid for our services, but we don’t touch the money between payer and provider. We’ve created an electronic world that allows them to do business together. What we get paid is a fraction of what the re-billing vendors are taking.

HME: What do you get paid and by whom?

Sullivan: There’s no fee to the provider. The payer pays us a percentage of their savings based on the difference between the state fee schedule allowed amount and the ClearPrice Networks price. That’s the same model that has been used in the PPO industry for the past 20-plus years. Everyone knows how that works.

HME: We don’t hear much about the workers’ comp market. Why is this a growing market for HME?

Sullivan: Many injuries are episodic in nature. No one goes to work thinking they’re going to get hurt—it just happens, and it tends to be orthopedically significant. You see a lot of bracing and related devices, and when there are surgical repairs, DME is often distributed.

HME: So how many payers are biting at your new model?

Sullivan: I can’t talk about any of them specifically, but all of the major insurers and TPAs (third-party administrators) have been customers of mine throughout my career and they love the idea that we’re bringing clarity and electronic payments to the market.